Study: PCPs as effective, less costly at managing sleep apnea than specialists

Increased awareness of obstructive sleep apnea in the 1990s has resulted in a steady demand and, therefore, long waits at specialty sleep centers. But a new report indicates that, when trained properly, primary care physicians (PCPs) can provide the same level of clinical care as sleep center specialists.

The study, published in the March 13 issue of the Journal of the American Medical Association, found that PCPs and specialists achieved the same results from their patients during the study period, but PCPs did it for about 40% less of the cost of the specialist.

“One-third of primary care patients report symptoms suggestive of obstructive sleep apnea. With appropriate training and simplified management tools, [PCPs] and practice nurses might be ideally positioned to take on a greater role in diagnosis and management,” according to the study. However, whether an ambulatory approach would be non-inferior (outcome not worse than treatment compared to) in a primary care setting is unknown, the report notes.

The study was conducted in Australia by Ching Li Chai-Coetzer, MBBS, PhD, of the Adelaide Institute for Sleep Health, Repatriation General Hospital, Daw Park, South Australia, to compare the clinical efficacy and within-trial costs of a simplified model of diagnosis and care in primary care relative to that in specialist sleep centers. The study included 155 patients with obstructive sleep apnea who were treated at primary care practices in Australia between September 2008 and June 2010. Both interventions included continuous positive airway pressure, mandibular advancement splints, or conservative measures only. The researchers found significant improvements in Epworth Sleepiness Scale (ESS) scores from baseline to 6 months in both groups.

“The mean [average] ESS for the entire study population was 12.6. The mean ESS scores in the primary care group improved from 12.8 at baseline to 7.0 at 6 months, for an adjusted mean difference of 5.8 and in the specialist group from a baseline mean of 12.5 to 7.0 at 6 months, for an adjusted mean difference of 5.4. After controlling for baseline ESS score and region, the adjusted difference in the mean change in the ESS score was -0.13,” according to the report.

No difference in secondary measures—symptoms of the condition and its affect on the patient’s quality of life—was observed between the groups studied in the specialty sleep centers versus the primary care practices. More patients withdrew from the study in the primary care group (21%) compared with the specialist group (6%). Cost analysis revealed that primary care management of the condition was roughly 40% less expensive that specialist care, with the equivalent cost per patient in U.S. dollars estimated at $1,819 in the primary care group and $3,068 in the specialist group.